In recent years, doubt has been cast on the existence of contrast-induced acute kidney injury. The skepticism has stemmed from observational studies from large administrative healthcare databases. Although they correctly call that contrast-induced acute kidney injury is less common than previously thought, they cannot completely exclude selection bias.
Though less common than previously thought, contrast-induced acute kidney injury still exists. The only prophylactic method that remains valid is that of isotonic volume expansion, which is still deemed beneficial in high-risk patients. N-acetylcysteine and sodium bicarbonate are ineffective and their use should be abandoned.
Contrast-induced kidney injury should be defined based on clinical grounds, not merely on biochemical numbers. More research to validate a clinical definition is necessary in order to accurately re-examine its incidence.
aDepartment of Medicine, University of Ottawa
bClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
cDepartment of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
dOchsner Clinical School/The University of Queensland, Brisbane, Australia
Correspondence to Swapnil Hiremath, MD, MPH, 1967 Riverside Dr, Ottawa, ON, Canada K1H7W9. Tel: +1 6137388400 x82762; fax: +1 6137388337; e-mail: firstname.lastname@example.org